<div class="contentPages">
    <div id="form-header" class=" size92 form-gray-stripe ">
        <h1>Remarcar Avaliacao</h1>
        <!--<img src="general/images/remarcarAvaliacao.png" width="60" height="60" alt="RemarcarAvaliacao"/>-->
    </div>
    <form name="pagamento" id="pagamento" class="formStyle size92 form-gray" action="#" method="post">
        <div class="field_inline">
            <fieldset class="fieldset-none">


                <label class="medium"><span class="full">Aluno  </span>
                    <select type="text" name="nome" value="{NOME}" class="size100" ><select/>
                </label>


                <div class="block">
                    <ul class="form-list-radio size60">
                        <li><input name="radio" type="radio" />
                            <em class="form-rdo"> Nome</em></li>
                        <li><input name="radio" type="radio" />
                            <em class="form-rdo"> Matrícula</em></li>
                    </ul>
                </div>

                <div class="boxButtons">
                    <input type="submit" class="form-buttom-gray mright-small" value="Pesquisar" />
                 </div>

              <label class="medium"><span class="full">Data Marcada</span>
                    <input type="text" name="datamarcada" value="dd/mm/aaaa" class="size100"/>
              </label>

              <label class="medium-1"><span class="full">Horário Marcado</span>
                    <input type="text" name="horariomarcado" value="hh:mm" class="size100"/>
              </label>

              <label class="medium"><span class="full">Nova Data </span>
                    <input type="text" name="data" value="dd/mm/aaaa" class="size100"/>
              </label>

              <label class="medium-1"><span class="full">Novo Horário </span>
                    <input type="text" name="horario" value="hh:mm" class="size100"/>
              </label>

            </fieldset>
              <div class="boxButtons mright-small">
            <input type="button" name="Cancelar" class="form-buttom-gray " value="Cancelar" />
            <input type="submit" name="Salvar" class="form-buttom-green " value="Salvar" />
            </div><!--- boxButtons --->

            </form>
     </div>